High levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injury
JournalAmerican Journal of Transplantation
PublisherBlackwell Publishing Ltd
MetadataShow full item record
AbstractThe clinical importance of subclinical, early T cell–mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor-derived cell-free DNA (dd-cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd-cfDNA. Forty-two patients had elevated dd-cfDNA (≥0.5%) and 37 patients had low levels (<0.5%). Elevated levels of dd-cfDNA predicted adverse clinical outcomes: among patients with elevated cfDNA, estimated glomerular filtration rate declined by 8.5% (interquartile rate [IQR] −16.22% to −1.39%) (−3.50 mL/min/1.73 m2 IQR −8.00 to −1.00) vs 0% (−4.92%, 4.76%) in low dd-cfDNA patients (P =.004), de novo donor-specific antibody formation was seen in 40% (17/42) vs 2.7% (P <.0001), and future or persistent rejection occurred in 9 of 42 patients (21.4%) vs 0% (P =.003). The use of dd-cfDNA may complement the Banff classification and to risk stratify patients with borderline/TCMR 1A identified on biopsy. Copyright 2020 The Authors.
cellular transplantation (non-islet)
kidney (allograft) function/dysfunction
rejection: T cell mediated (TCMR)
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85081281914&doi=10.1111%2fajt.15822&partnerID=40&md5=c16941d0a722866cf8debd3d11f1ffc6; http://hdl.handle.net/10713/12323
- Absolute quantification of donor-derived cell-free DNA as a marker of rejection and graft injury in kidney transplantation: Results from a prospective observational study.
- Authors: Oellerich M, Shipkova M, Asendorf T, Walson PD, Schauerte V, Mettenmeyer N, Kabakchiev M, Hasche G, Gröne HJ, Friede T, Wieland E, Schwenger V, Schütz E, Beck J
- Issue date: 2019 Nov
- Donor-derived cell-free dna as a biomarker for rejection after kidney transplantation: A systematic review and meta-analysis.
- Authors: Wijtvliet VPWM, Plaeke P, Abrams S, Hens N, Gielis EM, Hellemans R, Massart A, Hesselink DA, De Winter BY, Abramowicz D, Ledeganck KJ
- Issue date: 2020 Sep 27
- Donor-derived cell-free DNA (dd-cfDNA) for detection of allograft rejection in pediatric kidney transplants.
- Authors: Puliyanda DP, Swinford R, Pizzo H, Garrison J, De Golovine AM, Jordan SC
- Issue date: 2020 Nov 20
- Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: A prospective multicenter study.
- Authors: Khush KK, Patel J, Pinney S, Kao A, Alharethi R, DePasquale E, Ewald G, Berman P, Kanwar M, Hiller D, Yee JP, Woodward RN, Hall S, Kobashigawa J
- Issue date: 2019 Oct
- Cell-Free DNA and Active Rejection in Kidney Allografts.
- Authors: Bloom RD, Bromberg JS, Poggio ED, Bunnapradist S, Langone AJ, Sood P, Matas AJ, Mehta S, Mannon RB, Sharfuddin A, Fischbach B, Narayanan M, Jordan SC, Cohen D, Weir MR, Hiller D, Prasad P, Woodward RN, Grskovic M, Sninsky JJ, Yee JP, Brennan DC, Circulating Donor-Derived Cell-Free DNA in Blood for Diagnosing Active Rejection in Kidney Transplant Recipients (DART) Study Investigators.
- Issue date: 2017 Jul